title: Obstructive jaundice due to ampullary metastasis of renal cell carcinoma.
abstract: Renal cell carcinoma is often characterized by the presence of metachronous metastases in unusual sites. The presence of isolated metastases is treated with surgical excision with good anticipated results. On the other hand, systemic chemotherapy is administered in the context of metastatic spread, usually sunitib or sorafenib. In such cases, however, the presence of symptomatic foci calls for minimal intervention.We present a case of a 77-year-old patient who presented with obstructive jaundice due to an ampullary mass. Endoscopic excision and biopsy set the diagnosis of metastatic renal cell carcinoma. Consequently, imaging studies revealed the presence of multiple foci in the lungs and bone. Therefore, pancreatoduodenectomy was excluded and the patient underwent endoscopic ampullectomy and was set to oral sunitinib. Interestingly, despite generalized spread, local control was achieved until the patient succumbed to carcinomatosis.Painless obstructive jaundice in a patient with history of renal cancer and negative computed tomography scanning for pancreatic or other causes of obstruction should alert for prompt investigation for an ampullary metastasis.
authors.affiliation: 2nd Department of Surgery, Aretaieion Hospital, Medical School, National and Kapodistrian, University of Athens, Athens, Greece. andreas.karakatsanis@gmail.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Karakatsanis
authors.forename: Antonios
authors.initials: A
authors.lastname: Vezakis
authors.forename: Georgios
authors.initials: G
authors.lastname: Fragulidis
authors.forename: Chryssa
authors.initials: C
authors.lastname: Staikou
authors.forename: Eleni E
authors.initials: EE
authors.lastname: Carvounis
authors.forename: Andreas
authors.initials: A
authors.lastname: Polydorou
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D002292:Carcinoma, Renal Cell / Q000556:secondary*; D003138:Common Bile Duct Neoplasms / Q000556:secondary*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000473:pathology; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D011379:Prognosis